The Group Benefits Plan consists of the Health and Dental Plan and the Group Life Insurance Plan with Sun Life Financial. These plans can go through changes and updates from time to time and it is important to keep informed about how these changes may effect you. All up-to-date information will be provided on this page for any changes made.
Expanded Coverage for Continuous Glucose Monitors
Starting November 8, 2023, Sun Life is making changes to its Extended Health Care (EHC) coverage for Continuous Glucose Monitors (CGMs). This includes receivers, transmitters, and sensors.
Under our standard EHC plan, people with Type 1 diabetes currently have access to CGM coverage. To help you manage your health, we’re expanding this coverage to individuals with Type 2 diabetes who need insulin.
What you need to make a claim
We’ll need a doctor’s note confirming both the diagnosis and insulin use.
Questions? We’re here to help.
For more information or to chat live with us, sign in to mysunlife.ca
Sun Life is changing their pharmacy benefits manager to Express Scripts Canada.
Sun Life is transitioning all Sun Life Clients, with the exception of Clients with Deferred Payment Drug Cards, to Express Scripts Canada (ESC) on March 1, 2023.
The transition to ESC will happen automatically at the pharmacy. Sun Life is taking steps to provide a smooth and easy transition.
What’s changing?
A Pharmacy Benefits Manager helps Sun Life process your drug claims directly with your pharmacy.
What does this mean?
No action is required on your part. Sun Life is working with pharmacies across the country to make this change, and it will happen automatically in their systems.
At the pharmacy
In March, if you have any issues at your pharmacy, just let them know our new Pharmacy Benefits Manager is now Express Scripts Canada. Your pharmacist also has access to support from Express Script Canada if they need it.
Questions? We’re here to help.
Please contact the Client Care Centre at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET
It’s Fraud Prevention Month – some things you need to know
Health-care Service Provider Delisting
When Sun Life delists health-care service providers, clinics, facilities or medical suppliers (referred to as the “provider” below), we no longer process or pay for claims for services or supplies obtained from that provider. These providers are placed on a Sun Life “delisted providers” list.
Delisted Provider Update
Our list is updated regularly. To view newly delisted providers, you must sign in to your passwordprotected web page through mysunlife.ca and select the message for delisted providers.
We encourage you to check the list periodically. This will help you avoid using a delisted provider, which would result in your claim being declined.
We’ll Keep You Updated
When we delist a health-care service provider, we’ll send you a letter if you’ve submitted a claim for this provider in the last one or two years, depending on the specifics of your plan.
Why Delisting a Provider is Necessary
It’s important that only eligible claims are processed and paid. It allows us to better protect you, your employer and your group benefits plan.
Questions? We’re here to help.
Please contact the Client Care Centre at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET
Update: Changes to Your Dental Coverage – January 1, 2022
Sun Life regularly reviews their dental plans. Based on a recent review, there’ll be a change to scaling and root planing coverage.
Scaling and root planing remove plaque and tartar above and below your gum line. It’s a common procedure that can prevent future dental problems. A dentist or dental hygienist likely does this during regular dental checkups.
How your coverage is changing
As of January 1, 2022, the combined maximum for scaling and root planing per benefit year, will be:
• 10 units for you,
• 10 units for each dependent 13 and over, and
• 4 units for each child 12 and under.
One (1) unit is equal to 15 minutes of treatment. Claims data shows that 95% of claims for scaling and root planing are below 10 units per benefit year. For children, scaling isn’t needed to the same extent as adults. Flossing, for example, is a simpler treatment. That’s why the limit for children under age 13 is lower.
How this change will affect you
This change will only affect you if your dentist is currently charging you or your dependents, per benefit year:
• more than 10 units combined for scaling and root planing (for those 13 and over)
• more than 4 units combined for scaling and root planing (for those 12 and under)
If your dentist is currently charging you less than these limits, this change will have no effect on you.
Understanding your claims
Your claim statement will include an explanation of how your claim was processed . You can refer to this statement for more details on our payment decisions.
Have Questions?
Contact Sun Life by:
• Phone at 1-800-361-6212, Monday to Friday from 8 a.m. to 8 p.m. ET,
• live chat on mysunlife.ca, or
• sending a message by signing into mysunlife.ca.
You can also reach the Pension and Benefits Office by:
• Phone at 1-800-619-7301 ext 233, or
• email at pension [at] presbyterian [dot] ca
Flexibility for Health and Dental Coverage until June 30, 2021
Giving You the Care You Need: Changes to make it easier
We know you may not have access to your regular health-care providers right now. We’ll keep paying health claims up to June 30, 2021, that would normally require:
• additional documentation
• signatures
• referrals
• laboratory information, where we previously had this information on file and it has expired.
This includes:
• Prescriptions, nurse practitioner or doctor referrals for paramedical services
• Drug exception forms, which include prior authorization and special authorization
To make things easier for you, we’re accepting copies of forms. You can print the form, sign it and then submit a photograph of that document. You don’t need to mail us the original. You can send us the forms through the my Sun Life mobile app. You also have the option to send forms to us by mail or fax. It’s a small step that will help you get the continuity of care you need. Please take care and stay healthy!
Is your drug exception form expiring?
Starting in April, we’ll send a letter to you if you have a drug exception on file that is about to expire. The letter will explain the next steps to continue coverage for your drug exception.
Questions? We’re here to help.
Please call us at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.
Sleep Apnea: News About Claims
If you or one of your dependents has sleep apnea, please read this update.
Starting January 1, 2021, we’ll no longer reimburse for CPAP machines in cases of mild obstructive sleep apnea.
We’ll continue to reimburse Continuous Positive Airway Pressure (CPAP) machines for moderate and severe diagnoses.
The Canadian Agency for Drugs and Technologies in Health (CADTH) recommends lifestyle changes for mild obstructive sleep apnea, rather than CPAP machines.
CADTH defines mild sleep apnea as an Apnea-Hypopnea Index (AHI) of under 15.
Reminder: If you live in Ontario, Manitoba or Saskatchewan, your provincial health plan helps with costs.
If you have moderate to severe obstructive sleep apnea, apply to the province for funding before purchasing a CPAP. Once you have provincial approval for funding, you can buy your CPAP and send your claim to Sun Life.
Questions? We’re here to help.
Please call us at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.
Mass Contract Amendment – Nurse Practitioners
We’re pleased to announce that we’re updating your Extended Health Care (EHC) benefit effective, December 1, 2020. Where provincial law allows, we’ll clarify that nurse practitioners (NPs) can prescribe certain supplies and services.
Why we’re making this change We want to help you and your dependents get access to the care you need, when you need it.
Some examples of what a nurse practitioner (NP) can prescribe include certain paramedical services and medical equipment.
New contract wording
We’re adding this wording to the General description of coverage in the EHC section of your benefits plan:
Reference to Doctor may also include a nurse practitioner – If the applicable provincial legislation permits nurse practitioners to prescribe or order certain supplies or services, Sun Life will reimburse those eligible services or supplies prescribed or ordered by a nurse practitioner the same way as if they were prescribed or ordered by a doctor. For drugs, refer to Other health professionals allowed to prescribe drugs.
For ease of reference, the Other health professionals allowed to prescribe drugs is as follows:
Sun Life will reimburse certain drugs prescribed by other qualified health professionals the same way as if the drugs were prescribed by a doctor or a dentist if the applicable provincial legislation permits them to prescribe those drugs.
Your benefit plan already includes this term.
Questions? We’re here to help. Please call us at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.
Update: Changes to Sun Life’s dental claims practices
Earlier this year you may have read about Sun Life’s new dental administrative practices for desensitization services and certain exams. These new practices were going to be effective May 24, 2020. Due to COVID-19, Sun Life will be making these updates effective October 4, 2020.
Recall examination vs. emergency/specific examination
A recall examination (exam) occurs when you return to your dental provider for your regular appointment and you receive a cleaning and an exam. A recall exam is different from an emergency or specific exam.
An emergency exam occurs separately from a recall appointment when:
• your dental provider is required to check your pain points or discomfort, and/or
• an infection in a localized area requires immediate treatment.
A specific exam also occurs separately from a recall appointment. We pay for both emergency and specific exams but not as recall exams.
Desensitization with a routine hygiene appointment
During a hygiene appointment, your dental provider might apply a varnish to reduce sensitivity. There’s no needle involved. We don’t consider this eligible for an additional fee when claimed with scaling or root planing. We’ll decline the fee for desensitization if performed in conjunction with these services.
Understanding your claims
Your claim statement will include an explanation of how we processed your claim. You can refer to this statement for more details on our payment decisions.
Questions? We’re here to help.
Please call us at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET
New Access to Insurance Coverage Information
As a plan member with optional insurance benefits, you will now be able to see your coverage details on mysunlife.ca.
This includes:
● Basic and Optional Life
● Critical Illness (CI) and Optional CI
● Accidental Death & Dismemberment, if administered by Sun Life.
The link to this information is on the my Coverage page. As a plan member, you can access this page by clicking on Coverage information on the mysunlife.ca home page.
The details highlighted are:
● Policy name, number and effective date
● Current coverage amount
● Benefits you do not have but may be eligible for
As a plan member, you can also access coverage calculators and videos. These tools will provide you with health and wellness information.
Changes to Sun Life’s dental claims practices
Effective May 24, 2020, Sun Life is updating its dental administrative practices for desensitization services and certain exams.
Recall examination vs. emergency/specific examination
A recall examination (exam) occurs when you return to your dental provider for your regular appointment and you receive a cleaning and an exam by your dentist. If your dentist submits a specific or emergency exam with recall services, it is still considered a recall exam. The office should bill you for a recall exam, not a specific exam.
Sun Life considers an exam to be an emergency when:
◆ it occurs separately from a recall appointment, and
◆ your dentist is required to check your pain points or discomfort, and/or
◆ an infection in a localized area requires immediate treatment.
A specific exam is an exam that’s requested by a patient, to address issues outside of an emergency or recall exam.
Desensitization with a routine hygiene appointment
If a tooth is sensitive during or after deep scaling or root planning, your dental provider might put a chemical on the tooth. The provider usually applies desensitization as a varnish. There is no needle involved, so Sun Life considers this desensitization as part of the fee for your cleaning.
These rules apply to services performed by a general dentist or dental hygienist.
Understanding your claims
Your claim statement will include an explanation of how we processed your claim. You can refer to this statement to better understand payment decisions.
Please speak with your dentist if you have questions about their services.
Health-care Service Provider Delisting
When Sun Life delists health-care service providers, clinics, facilities or medical suppliers (referred to as the “provider” below), we no longer process or pay for claims for services or supplies obtained from that provider. These providers are placed on a Sun Life “delisted providers” list.
Delisted provider update
Our list has been updated. To view the newly delisted providers, you must log in to your own password protected web page through mysunlife.ca and select the message for delisted providers.
We encourage you to check the list periodically so that you don’t unknowingly use a delisted provider, which would result in your claim being declined.
Why delisting a provider is necessary
It’s important that only eligible claims are processed and paid. It allows us to better protect you, your employer and your group benefits plan.
Questions?
Please contact the Client Care Centre at 1-800-361-6212, Monday to Friday, 8 a.m. to 8 p.m. ET.